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NPI Code Detail

MEDICARE: NILI SHORE

MEDICARE: NILI SHORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1568137511
Entity Type Code : Individual
Provider Name (Legal Business Name) : NILI SHORE
Provider Business Mailing Address
First Line : 1398 CARROLL ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-4404
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1398 CARROLL ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-4404
Country : US
Telephone Number : 718-208-4780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2021
Last Update Date : 04/24/2022

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Directions to “ NILI SHORE ” Practice Location

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